HIPAA: Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Background

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to protect and maintain the privacy of our patient’s identifiable health information. The standards are meant to improve the efficiency and effectiveness of the nation’s health care system. We are dedicated and committed to implementing appropriate administrative, technical, and physical safeguards to protect the privacy of Protected Health Information.

Purpose

The purpose of this information is to:

provide our notice of information protection practices, and

explain your rights as our customer.

Our Responsibilities

We are required by law to:

Maintain the privacy of your Protected Health Information as necessary;

Provide you with a notice of our duties and privacy practices as to the information we collect and maintain about you;

Abide by the terms of this Notice;

Notify you if we cannot accommodate a requested restriction or request;

Notifying you of any breaches of your unsecured Protected Health Information.

Notice Revisions

We reserve the right to amend, change, eliminate provisions, or revise the terms or add new terms of this notice, and to make the revised terms effective for all Protected Health Information that it maintains. If we revise this notice, we will make the revised notice available on our website or you can request a paper copy of this notice.

DEFINITIONS

Business Associate

A person or entity that uses Protected Health Information to perform a service. These services include, but are not limited to:

billing

data entry

quality assessment and improvement

processing

third party activities that help in providing our services

Health Care

Operations

Activities related to our operations, including but not limited to:

protocol and guidelines development

training programs

credentialing

medical review

quality assessment and improvement

doctor performance evaluations

fraud and abuse detection

customer issue resolution

Payment

Collection of payment for our services

Protected Health Information

Information we create and obtain relating to a patient’s past, present or future health or condition. It also includes payment and billing for health care to a patient. Protected Health Information includes, but is not limited to:

Patient name

Date of birth

Address

Patient symptoms

Social Security number

Health service date

Diagnosis information

Payment information

Treatment

The provision, coordination or management of patient health and related services.

PRIVACY PRACTICES

How We Use And Disclose Information About You

We will only use and disclose your Protected Health Information without your authorization when necessary for:

coordination of your treatment

disclosure of your information to the extent permitted by law

payment

health care operations, or

needs required or permitted by law (e.g., release to FDA for reporting communicable diseases)

preventing or lessening a threat to the health or safety of the public

abiding to a court or administrative order.

Disclosure to Our Business Associates

We will only disclose your Protected Health Information to Business Associates who have agreed in writing to maintain the privacy of Protected Health Information as required by law.

Use or Disclosure Requiring Authorization

We will not use or disclose your Protected Health Information for purposes other than those described in this notice. If it becomes necessary to disclose any of your Protected Health Information for other reasons, we will request your written authorization. As permitted by law, we may contact you to obtain your authorization for any sale of Protected Health Information, or to use or disclose your Protected Health Information for marketing.

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health & Human Services (HHS) as a condition of receiving services from the laboratory.

Revoking Authorization

If you provide written authorization, you may revoke it at any time in writing, except to the extent that we have relied upon the authorization prior to its being revoked.

Use or Disclosure Required or Permitted by Law

We may use or disclose your Protected Health Information to the extent that the law requires the use or disclosure:

Public Health: For public health activities or as required by the public health authority.

Health Oversight: To a health oversight agency for activities such as audits, investigations and inspections. Oversight agencies include, but are not limited to, government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Legal Proceedings: In response to an order of a court or administrative tribunal, in response to a subpoena, discovery request or other lawful process.

Law Enforcement: For law enforcement purposes, including:– legal process or as otherwise required by law;– limited information requests for identification and location;– use or disclosure related to a victim of a crime;– suspicion that death has occurred as a result of criminal conduct;– if a crime occurs on our premises; or– in a medical emergency where it is likely that a crime has occurred.

Criminal Activity: As requested by law enforcement authorities, if the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Use and Disclosure Examples

Payment: We use Protected Health Information for payment processing.

Treatment: To coordinate treatment by a health care provider.

Personal Representative: We may disclose your Protected Health Information to a person who has legal authority to make health care decisions on your behalf.

Disclosure Requiring Opportunity to Object:

We may disclose your Protected Health Information to a family member, friend, or other person involved in your care or payment if the information is relevant to their involvement and you have agreed or had an opportunity to object.

You have a right to inspect and obtain a copy of your Protected Health Information.

Important: If you feel your Protected Health Information is incomplete or incorrect, you have the right to request that it be amended.

Request to Restrict Your Protected Health Information

You can request restrictions on the use and disclosure of your Protected Health Information. We are not required to agree to a requested restriction.

Example: If a restriction request prevents us from providing service to you or from performing payment related functions, we will not be able to agree to the request.

Confidential Communication

When necessary, we may seek to contact you by calling you at your home or by sending mailings containing your Protected Health Information to your home. If you feel that such communications could compromise your safety, you may request in writing an alternate communication method and/or location.

Important: At times, we may require that a request contain a statement that disclosure of part or all of the information to which the request pertains could endanger the individual, and we may, within the the extent of applicable laws, request payment for this service.

Accounting of Disclosures

If a disclosure of your Protected Health Information was made for a reason other than health testing, payment or healthcare operations, you have a right to receive an accounting of the disclosure. However, a disclosure made to you will not require an accounting.

Receive a Copy

You can view and print a copy of this Notice of Privacy Practices through our website, or you may request a paper copy.

Complaints

If you believe that your privacy rights have been violated, you may submit a complaint to us or to the U.S. Secretary of Health and Human Services at any time. We will not retaliate against you for filing a complaint. You may file a complaint with us through our website or through the details provided below under Contact Us.

Nondiscrimination Statement

We comply with applicable Federal civil rights laws and do not discriminate on the basis of gender, race, color, national origin, age, or disability.

CONTACT INFORMATION

Contact Us

If you have questions about your privacy rights or concerns about violation of your privacy rights, you may contact us at:

Attn: RxHomeTest.com

4640 SW Macadam Avenue, Suite 270D

Portland, OR 97239

971-205-2185

test@RxHomeTest.com

No more doctor appointments for prescription. No more lab visits for blood draw. Let us take care of all that while you work on things you love.